Medicaid Assistance Research Articles

The local fiscal multiplier of intergovernmental grants: evidence from federal medicaid assistance to states

The local fiscal multiplier of intergovernmental grants: evidence from federal medicaid assistance to states

Analyzing the demographics of patients with uveitis in an indigent, urban population

PurposeTo study the types of uveitis examined in a hospital serving indigent populations in need of low-cost care.MethodsA retrospective chart review examined the electronic medical records of all patients with uveitis-related at Drexel Eye Physicians. Data collected included demographics, anatomic location of the uveitis, systemic disease associations, treatment modalities and insurance. Statistical analysis was performed using χ² or Fischer exact tests.Results270 patients (366 eyes) were included for analysis, 67% of patients identified as African American. Most eyes (95.3%, N = 349) were treated with topical corticosteroid drops, and only 6 (1.6%) received an intravitreal implant. Immunosuppressive medications were started in 24 patients (8.9%). Nearly 80% depended to some extent on Medicare or Medicaid Assistance for treatment coverage. There was no association between insurance type and use of biologics or difluprednate.ConclusionWe found no association between insurance type and the prescription of medications for uveitis that should be used at home. There was a minimal number of patients prescribed medications for implantation in the office. The adherence of use of medications at home should be investigated.

Doubly Enhanced Medicaid Partnership Annuities (DEMPANs): A New Tool for Providing Long Term Care to Retired U.S. Seniors in the Medicaid Penumbra

A major problem facing many U.S. retirees is accessing and paying for long term care. The 2019 National Association of Insurance Commissioners (NAIC) guide on long-term care insurance estimates that, of the individuals living in the United States who reach age 65, about 70% are expected to need some form of long-term care at least once in their lifetime and about 35% are expected to enter a nursing home at least once in their lifetime. Although Medicare covers most of a U.S. retiree’s medical care, Medicare does not ordinarily pay for long-term care. U.S. retirees often can access long-term care services via the Medicaid program, which is a means-tested program geared to lower income Americans. But, to quickly qualify for Medicaid, many retirees take drastic steps, such as transferring their assets to family members. When access to long-term care is not urgent and long-term planning is an option, most U.S. states have developed so-called Partnership for Long-Term Care (PLTC) Program insurance policies that provide access to Medicaid services while sheltering some or all of a retiree’s assets. In this article, we propose a hybrid annuity product called a doubly enhanced Medicaid partnership annuity (DEMPAN) that combines an annuity with a long-term care rider that is integrated within the framework of a qualified partnership policy. (Outside the United States, bundled retirement products similar to DEMPANs are often called life-care annuities.) To analyze our DEMPANs, we use a multistate model of long-term care with health states that are based on a retiree’s ability to perform activities of daily living (ADLs) and instrumental activities of daily living (IADLs) and cognitive ability. A significant contribution of this article is to explicitly model how the quality of long-term care a retiree receives affects the retiree’s health state transition probabilities used in the multistate model. As higher quality of care usually comes at a higher cost but with better health outcomes, we provide an example that explores an expected discounted utility maximizing retiree’s optimal choice of DEMPAN. Our example showed that it may be optimal for retirees who purchase DEMPANs to simply buy average quality long-term care. We hope DEMPANs fill a gap in the long-term care market by providing an important tool for elder care planning for those in the Medicaid penumbra (i.e., in the middle- and lower-middle-income classes). Retirees who purchase DEMPANs have the benefits of an annuity, private long-term care, Medicaid assistance with paying their long-term care bills, and some degree of asset protection from Medicaid estate recovery.

The Local Fiscal Multiplier of Intergovernmental Grants: Evidence from Federal Medicaid Assistance to States

Advocates of Medicaid expansion argue that federal Medicaid assistance to states fosters economic activity, generating positive local multiplier effects. Furthermore, during economic downturns, Congress regularly tweaks federal match rates for state Medicaid spending – including during the COVID-19 public health emergency – in order to assist states. Despite heavy reliance on Medicaid funding formulas, identifying the economic effect of these federal transfers has proved challenging. This is because federal Medicaid assistance (to states) is endogenous, since funding levels are correlated with unobserved factors driving state economic activity. To address this concern, we construct an instrument based on a slope discontinuity in the federal matching rate for state Medicaid spending. Using state-level panel data from 1990 to 2013, we find that federal Medicaid assistance does stimulate economic activity, but the implied cost per job created is quite high and the multiplier is well below 1. Despite modest economic effects over the entire sample period, we find that federal Medicaid assistance provided powerful fiscal stimulus to states after the Great Recession when the implied multiplier shot up to 1.5.

The Local Fiscal Multiplier of Intergovernmental Grants: Evidence from Federal Medicaid Assistance to States

Advocates of Medicaid expansion argue that federal Medicaid assistance to states fosters economic activity, generating positive local multiplier effects. Furthermore, during economic downturns, Congress regularly tweaks federal match rates for state Medicaid spending – including during the COVID-19 public health emergency – in order to assist states. Despite heavy reliance on Medicaid funding formulas, identifying the economic effect of these federal transfers has proved challenging. This is because federal Medicaid assistance (to states) is endogenous, since funding levels are correlated with unobserved factors driving state economic activity. To address this concern, we construct an instrument based on a slope discontinuity in the federal matching rate for state Medicaid spending. Using state-level panel data from 1990 to 2013, we find that federal Medicaid assistance does stimulate economic activity, but the implied cost per job created is quite high and the multiplier is well below 1. Despite modest economic effects over the entire sample period, we find that federal Medicaid assistance provided powerful fiscal stimulus to states after the Great Recession when the implied multiplier shot up to 1.5.

Poorer outcomes of all low birth weight groups at age 10: Missouri statewide case-control study

BackgroundIn 1989–1991, a population-based cohort of every Missouri birth weighing < 1500 g was identified over a 16-month period. Infants born moderately low birth weight (MLBW, 1500–2499 g) and normal birth weight (NBW, ≥ 2500 g), were matched to < 1500 g infants by delivery date, race, maternal age, and residence. AimsTo compare outcomes of extremely low birth weight (ELBW, < 1000 g), very low birth weight (VLBW, 1000–1499 g), and MLBW, to NBW infants at age 10. Study designA population-based cohort and matched case-control study Outcome measuresA Child Health and Development Questionnaire developed for this study collected social, medical, educational and special services history. The Conners’ Parent Rating Scale-Revised was also completed by parents/caregivers. ResultsAs birth weight declined, the prevalence of adverse outcomes increased. Children in all LBW groups were more likely than NBW children to have problems in speech and language, vision, fine and gross motor tasks, illnesses, attention, school performance, and increased requirements for therapy and accommodation. Repetition of a grade was three times higher for MLBW children and over three times higher for the other LBW groups. ConclusionIn this statewide population-based study, controlling for child’s sex, mother’s age, race, residence, education, marital status, Medicaid assistance, and smoking or alcohol use during pregnancy, failed to eliminate the strong effect of decreasing birth weight. Problems were most frequent in ELBW, however, VLBW and MLBW also had many significantly greater problems than NBW children. All LBW groups of children experienced greater adverse health and developmental outcomes resulting in significant habilitation and educational challenges.

Multiplex genomic testing (MGT): Four-year real-world experience of two community oncology practices in central rural Nebraska.

e14728 Background: MGT forms the basis of precision oncology. More and more community oncology practices are utilizing MGT to identify somatic Actionable Alterations (AA) in solid tumors. This information is increasingly being used to choose FDA and/or guideline approved treatment options, or clinical trials. Methods: From July 2014 to July 2018, MGT (Foundation Medicine) data of patients (pts) with solid tumors at two community hospital-based oncology practices in central rural Nebraska were retrospectively analyzed. Study population consisted of advanced solid tumor pts (ECOG 0-2) with an available MGT result who had progressed on standard treatment regimens. Treating community oncologists directed treatment choices based on MGT results. Results: 360 pts underwent MGT. Average (avg) turn-around time from order to reporting was 20.19 days. Reimbursements were through commercial insurance (27 %), Medicare (66%), Medicaid (3%), self-pay (2 %) and financial assistance by company (2%). Most common cancer types were non-small cell lung (27%), pancreas (9%), colon (8%), unknown primary (4%), sarcoma (4%), breast (4%), gastro-esophageal (2%) and kidney (1%). 79% of samples had at least one AA. In 69 (19%) pts these alterations were matched to one or more on/off label FDA and/or guideline approved targeted therapies. Only 26/69 pts (37%) in this group were able to have a therapy that was new. 43 (12%) of pts qualified and went on locally available clinical trials (MATCH, LUNG-MAP and TAPUR). Conclusions: Our analysis reflects a 4-year real-world MGT experience in two community oncology practices in central rural Nebraska. In addition to established barriers of cost, long turnaround time, adequate tissue, the low yield of new FDA and/or guideline approved treatments decreases the utility of MGT. Increased variety and availability of precision medicine clinical trials with improved patient access in the rural setting may improve this shortcoming.[Table: see text]

The Role of Annuitized Wealth in Post-retirement Behavior

This paper develops a tractable model of post-retirement behavior with health status uncertainty and state-verification difficulties. The model distinguishes between annuitized and non-annuitized wealth and features means-tested Medicaid assistance with nursing home care. We show how to solve the potentially complex dynamic problem analytically, making it possible to characterize optimal behavior with phase diagrams. The analysis provides an integrated treatment of portfolio composition and consumption/wealth accumulation choices. We show the model can explain both the “retirement-saving puzzle” and the “annuity puzzle.” (JEL D14, D15, G11, I18, I38, J14, J26)

Health Care Options Growing for Family Caregivers

Health Care Options Growing for Family Caregivers

The extent and patterns of multiple chronic conditions in low-income children.

Little is known about the magnitude of multiple chronic conditions (MCC) in children. This study describes the prevalence of and patterns of comorbidities in children receiving Medicaid assistance. Diagnoses from 5 years of Medicaid claims data were reviewed and identified 128,044 children with chronic conditions. The relationship between comorbidities and significant urgent health care events was analyzed using logistic regression modeling. More than 15,000 children (12%) had claims for more than 1 condition. The most frequent combination was asthma and allergic rhinitis. Significant health care events ranged from 18% to 51% in children, and the odds of having a significant event increased with each additional condition. Those with ≥4 conditions had 4.5 times the odds of a significant event compared with those with 1 condition (P < .0001). MCC are prevalent in low-income children and are associated with greater risk for urgent health care use.

Spending for 'Anti-Poverty' Programs: Restoring a True Safety Net

Federal spending increases for what used to be known as “anti-poverty” programs — food, health insurance, housing, and income support — have become staggering. These programs grew by $100 billion during the eight years of the Bush administration (adjusting for inflation), but they grew by another $150 billion in just the first two years of the Obama administration. Total spending for these four safety net programs stood at $666 billion in 2010, a total larger than Medicare and just slightly smaller than Social Security and national defense. Some of these increases are justified by the deep recession that began in late 2007, due to higher rates of unemployment and poverty. But average benefits per person in poverty increased from $7500 during the early 1990s recession compared to $14,600 for the recent one (correcting for inflation). If all these monies and services were going to the poor, our question would be why the safety net became more costly. Most remarkable, however, and rarely discussed, is that much of the cost increase is explained by benefits going to persons who are above the official poverty line. Today, at least half of the benefits for food programs, Medicaid, and most income assistance programs are going to people who are above the poverty line as defined by the U.S. Census. Federal food program expenditures for 2010 totaled $95 billion, up from just $57 billion in 2007. Most of these expenditures were for food stamps ($68 billion). Of the 40.3 million persons receiving food stamps in 2010, slightly more than half, or 20.4 million, were above the official poverty line as measured by the U.S. Census. Of the 43.8 million non-disabled persons receiving Medicaid and CHIP benefits, fully 25 million are above the official poverty line. More than half of the recipients of Earned Income Tax Credits (EITC) and traditional welfare (TANF) are above the official poverty line. Of the major programs we reviewed, only the federal housing assistance program did not have a majority of recipients above the poverty line. Nevertheless, four out of ten persons receiving housing subsidies are over the line. The debate over federal budget deficits focuses unduly on Medicare and Social Security. The combined spending on anti-poverty programs, and their rate of growth, offers an alternative for reduced federal spending. While anti-poverty programs should clearly help those who are poor, the general public (and perhaps many in Congress) may not be aware that we are giving billions in benefits to persons above the poverty line. By bringing these programs into line with their original purposes, a safety net for the poor, we can save up to $200 billion per year — without reducing benefits for the truly needy.

Misperceptions of Medicaid Ineligibility Persist among African American Caregivers of Alzheimer's Dementia Care Recipients

African American caregivers of the elderly, including those who care for patients with Alzheimer's and other forms of dementia, remain underserved by Medicaid Assistance Programs. The purpose of this exploratory study was to ascertain to what degree participants in an Alzheimer's Association program that primarily targeted African Americans applied for and received Medicaid assistance, in particular for adult day care, in-home care, and respite care. Secondary data from the Delaware Regional Office of the Alzheimer's Association's 2006 Caregiver Survey of 38 caregivers were reviewed using descriptive, chi-square, and logistic regression analysis. Results indicate that 20 caregivers applied for Medicaid services, 12 of whom were approved. However, 18 caregivers did not apply for Medicaid mainly because they perceived that they would not qualify for benefits, without investigating their eligibility. Clearly more education is needed in African American communities about the eligibility requirements and benefits of Medicaid Assistance Programs because services such as adult day care, in-home care, and respite care have been shown to reduce some of the burden, stress, and strain associated with caring for elderly patients with Alzheimer's dementia. However, a multisystem approach should be used in the outreach and education processes. Finally, the Medicaid application process should be streamlined to make it less cumbersome. More financial and support services are needed by African American caregivers of Alzheimer's care recipients.

Medicaid Funding Boost May Rescue At-Risk MH Services

Back to table of contents Previous article Next article Government NewsFull AccessMedicaid Funding Boost May Rescue At-Risk MH ServicesRich DalyRich DalySearch for more papers by this authorPublished Online:3 Sep 2010https://doi.org/10.1176/pn.45.17.psychnews_45_17_019AbstractMany states whose revenues have plunged due to the recession will be able to avoid implementing massive reductions in their Medicaid programs following congressional passage of a bill that extends federal financial assistance to those programs.About $16 billion in Medicaid assistance was included in a $26 billion measure (HR 1586) passed in August and signed by President Obama that will also provide states with funds to rehire public-school teachers and other state and local government workers who lost their jobs due to funding cuts resulting from budget shortfalls.The Medicaid appropriation will extend by an additional six months—to June 30, 2011—an increase in federal Medicaid payments to the states, known as the Federal Medical Assistance Percentage, that was enacted as part of the federal stimulus measure (PL 111-5).About 60 percent of states had already passed budgets that assumed the federal government would provide the additional Medicaid assistance in the wake of falling tax revenues during the recession. If the added federal funding had fallen through, those state legislatures would have had to scramble to find sufficient cuts or tax increases to make up the difference.The National Governors Association, in a letter to congressional leaders, said that the states' total estimated budget shortfall for the 2010-2012 period is expected to be $116 billion. The letter described the extended Medicaid payments as “the best way to help states bridge the gap between their worst fiscal year and the beginning of recovery.” Medicaid is dually funded by states and the federal government. The measure provides a 6.2 percent across-the-board increase to each state's Medicaid program and extra funding for states with the highest unemployment rates.The federal Medicaid boost was urged by mental health advocates, who were alarmed that many states had already sought budget savings through cuts in their mental health programs and that more such cuts could result from a lack of additional federal assistance.For instance, Michigan Gov. Jennifer Granholm (D) said in July that her state would cut mental health and prescription drug coverage under its Medicaid program if the state didn't receive the full $560 million it needed in federal Medicaid assistance, according to local media reports.“Medicaid is the primary funder of community-based mental health services and supports, including psychiatric rehabilitation and intensive case management,” said Laurel Stine, director of federal relations at the Bazelon Center for Mental Health Law. “The passage of this extension will help ensure that states can continue providing vital health care and recovery-oriented services and help fulfill community integration efforts for many individuals with disabilities.”Those who urged Congress to increase Medicaid funding highlighted the program's expansive coverage—compared with many private insurance plans—of treatment for psychiatric illnesses. Medicaid is already the largest single payer for mental health care in the United States, funding about 25 percent of such care. Advocates link the current number of Americans who have recently turned to Medicaid for their mental health care to their difficulties finding jobs that offer health insurance while struggling with the challenges of psychiatric illness.But funding mental health treatment could actually save states money by avoiding other costly medical and criminal-justice spending on people whose untreated mental illness results in deterioration of their condition. For instance, the New England Healthcare Institute estimated that the cost of poor medication adherence—linked to increased hospitalizations and worsening of illnesses—already reaches $290 billion annually, or 13 percent of all health care expenditures.Republicans in Congress objected to the Medicaid measure because of the way it is to be paid for, which is in part through raising $10 billion in taxes from U.S.-based multinational companies, while antipoverty activists complained that other offsets would phase out an increase in food-stamp payments implemented through the stimulus measure.More information on the state aid package is posted at <http://dpc.senate.gov/dpcdoc.cfm?doc_name=lb-111-2-133>. ISSUES NewArchived

Clinical outcomes of obese low socioeconomic status women diagnosed with invasive breast cancer.

Abstract Abstract #6092 Background: Obesity a possible risk factor for breast cancer development, may along with low socioeconomic status (LSES) influence breast cancer outcomes. Louisiana a state with the second highest level of poverty has an obesity prevalence above 25%. The Feist-Weiller Cancer Center (FWCC) provides oncology care to the majority of LSES patients (pts) in the nothern half of the state. This study examines if there is a difference in clinical outcomes in obese patients with invasive breast cancer treated at FWCC.&amp;#x2028; Methods: The electronic medical records of pts with histologically proven invasive breast cancer diagnosed between 1981-2006 at FWCC were reviewed. Pts with Stage IV breast cancer at diagnosis were excluded. Data on insurance, race, body mass index at diagnosis (BMI), stage, disease free interval (DFI) and survival time was analyzed. National Institutes of Health criteria was used to stratify pts into normal weight (NW)[ BMI &amp;lt;25 kg/m2], overweight (OW) [BMI 25-30 kg/m2], and obese (OB)[BMI &amp;gt;30 kg/m2]. LSES was defined as pts who were either uninsured or received Medicaid assistance. Differences in DFI and Overall survival (OS) were analyzed by BMI.&amp;#x2028; Results: 647 pts were analyzed, 49% were obese and 29% were overweight. 47% were African Americans and 53% were Caucasians. 49% had LSES (22% uninsured and 27% received Medicaid). Obese pts were more likely to be African American (58%; p&amp;lt;0.001), LSES (57%; p=0.003), with Stage III breast cancer at diagnosis (23%; p=0.003) and to develop contralateral breast cancer after the initial diagnosis (10%; p=0.003). One hundred seventy three (27%) pts relapsed (90 obese and 82 non obese) and 74 (11%) deaths occurred (37 obese and 40 non obese). Obese pts had a shorter median DFI (56 months) in comparison with NW and OW pts (67 months and 70 months, respectively) however this difference was not statistically significant (p=0.43). Regarding OS, there were no statistically significant differences between BMI groups. In multivariate analysis using Cox regression model, after adjusting for race, SES, stage at diagnosis, menopausal status, age at diagnosis, smoker status, obesity remains as a none significant predictor of time to relapse. (HR=1.3; p=0.12)&amp;#x2028; Conclusion: Our results suggest that African American race, low socioeconomic status, stage III at diagnosis and contralateral breast cancer occurrence are associated with obesity at diagnosis of invasive breast cancer. In our patient population, obesity did not appear to contribute to increase risk of relapse or shorter OS. Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 6092.

The Responsiveness of Private Savings to Medicaid Long Term Care Policies

This paper examines the extent to which private savings responds to the availability of a social insurance program. We focus on the Medicaid nursing home assistance program and uses variation in state Medicaid policies in the 1960s and 1990s to identify whether household wealth correlates negatively with access to public insurance coverage. We use data from the 1962 and 1970 Survey of Consumer Finances and the 1992 through 2002 Health and Retirement Study. We find that household savings in 1970 was substantially lower in states with easier access to Medicaid assistance and that household savings in the 1990s was lower when access to the Medicaid program was lower.

More AL Communities Abandon Medicaid

More AL Communities Abandon Medicaid

Sociodemographic Factors Associated With Weekend Birth and Increased Risk of Neonatal Mortality

To learn whether weekend risk of neonatal mortality is related to selected sociodemographic factors. A retrospective cohort design. Logistic regression was used to obtain odds ratios, and analysis of variance and chi-square to identify differences in values and incidence of key variables. The data were derived from matched Texas birth and infant death certificates from 1999 through 2001. A subset of deaths up to 28 days of life attributable to conditions originating in the perinatal period. These deaths were called neonatal mortality-p. Women who were White, married, had Medicaid assistance, and had private prenatal care were less likely to deliver on weekends. Odds of neonatal mortality-p increased 36.5% when a birth took place on the weekend. The weekend crude odds of neonatal mortality-p increased for all racial/ethnic groups, but the differences were not statistically significant. The likelihood of delivering on the weekend increases with certain sociodemographic factors. This fact is important because the risk of neonatal mortality is higher among weekend births.

Health Insurance for Women Who Have Left the TANF Rolls

SUMMARY Interviews with 215 recent welfare leavers are summarized. Women's access to health care, their health status, and rates of unmet need were examined. The impact of prior mental health contacts on these issues was also examined. About 31% were uninsured. Women in poorer health were more likely to have insurance than women in better health. This was not true for mental health; women were equally likely to lack insurance regardless of mental health status. Working women with prior mental health contacts were less likely to have employer-based coverage than those without contacts. Women informed about Transitional Medicaid Assistance were 2.5 times more likely to have coverage. The need for insurance was highlighted given 10% to 27% of the women had unmet health/mental health needs. The findings reveal the need to ensure that women leaving TANF do not lose access to basic health care and document the challenges health-related problems pose for many attempting to achieve self-sufficiency.

Government Loosens Medicaid Rules In Hurricane's Wake

Back to table of contents Previous article Next article Community NewsFull AccessGovernment Loosens Medicaid Rules In Hurricane's WakeKate MulliganKate MulliganSearch for more papers by this authorPublished Online:7 Oct 2005https://doi.org/10.1176/pn.40.19.00400007aAt the beginning of a two-day tour of Texas shelters on September 13, Mike Leavitt, secretary of Health and Human Services, announced, “For those persons with evacuee status, we are stripping away many of the eligibility and enrollment requirements normally needed to apply for federal benefits.”He said, in a press release dated the same day, that states would be given flexibility to enroll evacuees without requiring documents such as tax returns or proof of residency.The Houston Chronicle reported on September 16 that Texas would be permitted to create a new Medicaid eligibility category for evacuees, which would include only those traditionally eligible for Medicaid. The federal government would pay the full costs for that group, according to the story.Details about how this temporary program might work were scant, however. Here, for example, is a central question about the program that appeared on the official Web site of the Centers for Medicaid and Medicare (CMS) on September 18 and the answer:Question: At what point will individuals no longer be treated as“ hurricane victims”? Is there a set period of time or does it vary by individual?Answer: The waiver authority does not vary by individual—it applies to the geographic area in which the emergencies have been detected. In addition, the waiver authority is geared toward requirements upon providers, not individual beneficiaries. However, the effect of the waiver may vary somewhat from individual to individual, depending not upon the waiver authority itself, but rather upon whether that person has been evacuated to a facility for which requirements have been waived (as opposed to a facility to which the waiver does not apply).Problems of definition appear simple by contrast to issues concerning money.Senate Majority Leader William Frist, M.D. (R-Tenn.), said he is “not convinced” that an expansion of Medicaid is necessary but added that it is “likely that the federal government is going to have to step up more,” according to a report on the Web site<www.kaisernetwork.org> on September 16.Legislation concerning Medicaid coverage for Katrina survivors has been introduced in both houses of Congress. Here are the bills, summarized from material on the Web site of the National Association of State Medicaid Directors on September 18.H 3671 provides 100 percent Federal Medicaid Assistance Percentage (FMAP) to states providing medical assistance to evacuees.H 3698 provides “uniform eligibility rules” that include“ no income, resources, residency, or categorical eligibility requirements.” Eligibility can be determined “after the disaster.” The bill also increases FMAP to states that provide medical assistance to evacuees and postpones the cutoff of Medicaid prescription drug coverage that is scheduled to take place January 1 for beneficiaries who are also eligible for Medicare. The bill also halts scheduled reductions of FMAP in 2006.HR 3708 provides states with 10 percent of Hurricane Katrina disaster relief funds for mental health services to cover the states' share of Medicaid and the costs of the State Children's Health Insurance Program (SCHIP) for those services. The bill also provides states 10 percent of Hurricane Katrina disaster relief funds, without cost sharing, for reimbursement of mental health professionals for outpatient mental health treatment and prescription medication.S 1688 provides 100 percent FMAP to states for Medicaid and SCHIP for evacuees and streamlines the application process.S Amendment 1652 makes all “displaced persons” below the federal poverty level eligible for Medicaid. It also provides 100 percent FMAP for Medicaid and SCHIP in Alabama, Mississippi, and Louisiana and for displaced individuals from those states.S 1637 authorizes disaster emergency Medicaid to ensure that“ low-income” evacuees from Louisiana, Mississippi, and Alabama are eligible for medical assistance in any state. It also provides a simplified application process and guarantees drug coverage for Medicare-eligible individuals. States affected by Katrina would be given temporary financing and 100 percent FMAP for services to “low-income” evacuees.APA and more than 100 other organizations asked Congress in a letter dated September 14 to provide full financial support for emergency Medicaid and to streamline eligibility and documentation requirements (see story on page 7).Updates about proposed legislation and other issues concerning Katrina survivors and Medicaid are available on the CMS Web site at<www.cms.hhs.gov/katrina/> and the Web site of the National Association of State Medicaid Directors at<www.nasmd.org>.▪ ISSUES NewArchived

Medicaid's Unseen Costs

Medicaid occupies a special place among government programs for the poor. Public support for Medicaid is broader and deeper than for other safety net programs because the consequences of inadequate medical care can be much more immediate and severe than those of a lack of money or even food. Medicaid is now larger than Medicare (the federal health program for the elderly and disabled) and is the single largest item in state budgets, even larger than elementary and secondary education. Yet Medicaid imposes additional hidden costs. Like all means-tested government programs, Medicaid discourages work and charitable effort among the taxpayers who fund it, while discouraging self-sufficiency and encouraging dependence among beneficiaries. Medicaid also imposes costs that stem from overuse of medical care, increasing costs for private payers, and giving patients poorer quality care than they could obtain with private coverage. As it did with federal cash assistance, Congress should: (1) cap federal Medicaid spending, (2) block grant federal funds to the states, and (3) allow states full flexibility to define eligibility and benefits under their Medicaid programs. States should use that flexibility to target Medicaid assistance to the truly needy, reduce dependence, reduce crowd-out of private effort, and promote competitive private markets for medical care and insurance. That means withdrawing assistance from those who are most able to obtain coverage elsewhere and deregulating health care and health insurance markets so they can meet that need.